Limitations of percutaneous techniques in the treatment of portal vein thrombosis

New therapeutic alternatives to portal vein thrombosis (PVT) include the percutaneous, transhepatic infusion of fibrinolytic agents, balloon dilatation, and stenting. These maneuvers have proven to be effective in some cases with acute, recent PVT. We have treated two patients with acute PVT via transhepatic or transjugular approaches and by using pharmacologic and mechanical thrombolysis and thrombectomy. Although both patients clinically improved, morphologic results were only fair and partial rethrombosis was observed. The limitations of percutaneous procedures in the recanalization of acute PVT in noncirrhotic patients are discussed.     

A new rotational thrombectomy catheter: System design and first clinical experiences

Purpose: To describe a new catheter for the percutaneous mechanical removal of fresh and organized thrombi, and to assess its efficacy and safety in vitro and in vivo. Methods: The catheter consists of a coated stainless steel spiral that rotates at 40,000 rpm over a guidewire inside the whole length of an 8 Fr, single-lumen, polyurethane catheter, driving a dual-blade cutting crown. Abraded occlusion material is sucked into the catheter head through distal side holes and transported by the spiral into a reservoir at the proximal end. The efficacy of the device was tested in arterial models and fresh bovine carotid arteries (n = 72). In a clinical pilot study 10 patients (8 women, 2 men; mean age 70.6 ± 10.1 years) with occlusions of the superficial femoral artery (2–12 cm, mean 5.8 cm), not older than 4 weeks, underwent thrombectomy with the new catheter. Results: In arterial models and bovine cadaver arteries the catheter completely removed fresh thrombi. Occlusion material of higher consistency was cut into particles of 100–500 μm and transported outside. Thrombectomy was successful and vessel patency restored in all 10 patients. The ankle/brachial pressure index significantly (p < 0.0005) increased from 0.41 ± 0.18 before intervention to 0.88 ± 0.15 after 48 hr and to 0.84 ± 0.20 after 3 months. Two reocclusions occurred within 14 days after the intervention. Conclusion: Thrombectomy with the new device appears to be feasible and safe in patients with acute and subacute occlusions of the femoropopliteal artery.     

Deep venous thrombosis: comparison of indirect multidetector CT venography and sonography of lower extremities in 26 patients

OBJECTIVE: To compare the accuracy of indirect mutidetector row computed tomographic (MDCT) venography with lower extremity venous sonography for the diagnosis of femoropopliteal deep venous thrombosis (DVT), and to determine the frequency and location of DVT at MDCT venography. MATERIALS AND METHODS: Twenty-six consecutive patients suspected of having pulmonary embolism (PE) underwent both combined MDCT venography and MDCT pulmonary angiography and lower extremity venous sonography. Indirect MDCT venography was acquired from the upper calves to the mid-abdomen following MDCT pulmonary angiography. The CT venographic findings were compared with those of sonography for the diagnosis of femoropopliteal DVT. All CT scans were also reviewed for the frequency and location of DVT. RESULTS: Indirect MDCT venography disclosed DVT in 19 patients, and 12 of whom also had PE. Seventeen patients with thrombosis in the femoropopliteal veins were identified in both indirect MDCT venography and sonography. The sensitivity and specificity of indirect MDCT venography for femoropopliteal DVT, as compared with sonography, were both 100%. In one patient DVT in the superficial femoral vein was detected using only indirect MDCT venography. MDCT venography also showed superior extension of femoropopliteal DVT to the inferior vena cava and iliac veins in four patients and thrombosis isolated to the inferior vena cava and common iliac vein thrombosis in one patient. CONCLUSIONS: Indirect MDCT venography is as accurate as sonography in the diagnosis of femoropopliteal DVT. MDCT venography can further reveal thrombus in large pelvis veins and the inferior vena cava, an important advantage over sonographic screening for DVT.     

Fibrinolytic therapy for deep vein thrombosis and pulmonary embolism

The troublesome sequelae of pulmonary embolism (PE) and deep vein thrombosis (DVT) justify an aggressive therapeutic approach. Results of anticoagulation in patients with DVT have shown that a significant percentage of patients have no clot resolution and may progress to develop the postphlebitic syndrome. Lytic therapy has been more effective, with patients showing improvement within 24 h of treatment. This approach has also been found to compare favorably with anticoagulation in the treatment of PE. Preliminary research also suggests a potential role for recombinant human tissue-type plasminogen activator to resolve PE.     

经皮血栓碎吸联合血管成形治疗髂静脉压迫综合征并深静脉血栓形成

目的探讨经皮血栓碎吸联合血管成形治疗髂静脉压迫综合征并下肢深静脉血栓形成的临床效果。资料与方法回顾性分析184例髂静脉压迫综合征并下肢深静脉血栓形成的病例资料。经皮穿刺患侧股静脉,在导丝引导下采用12～14 F鞘管抽吸髂、股静脉内血栓;对于股、腘静脉血栓,利用Fogarty球囊导管将血栓碎解、拖拉至髂静脉内,再行机械性血栓抽吸术。对髂静脉严重狭窄或闭塞者,行经皮腔内血管成形术或支架置入治疗。结果本组血栓清除率Ⅲ级80.98%,Ⅱ级19.02%;出院时患肢膝上、下15 cm 周径为（43.9±4.7） cm、（31.5±4.1） cm,与入院时相比其间差异有统计学意义（t=6.43,t=5.79,均P=0.000）。随访6～24个月,治疗有效率为97.75%;178例支架置入病人术后6、12、24个月彩色多普勒超声或 DSA 复查,支架通畅率为97.19%、94.94%、92.13%。结论血栓碎吸联合血管成形治疗髂静脉压迫综合征并下肢深静脉血栓形成,其近、中期疗效显著,住院时间短,是一种安全有效的介入治疗方法。     

放射性核素显像对下肢深静脉病变和肺栓塞的临床观察

为研究下肢深静脉血栓形成与肺栓塞发病之间的关系，对１７１例临床诊断为下肢静脉病变者，使用９９ｍＴｃ大颗粒聚合白蛋白（ＭＡＡ）进行下肢深静脉和肺灌注显像。其中１０例行Ｘ线下肢静脉造影，１８例肺栓塞患者行ＤＳＡ检查，１５例行ＭＲＩ检查。结果：下肢深静脉及肺灌注显像可见１７１例下肢静脉病变患者中有９８例（５７３％）合并肺栓塞；９８例肺栓塞患者中股静脉以上梗阻为７９例，占８０６％。与ＤＳＡ、ＭＲＩ和Ｘ线下肢静脉造影检查的符合率分别为８８９％、８６７％和９００％。故核素下肢深静脉显像结合肺灌注显像是诊断下肢深静脉血栓和肺动脉栓塞的有效方法。     

99 Tcm-MAA肺显像对深静脉血栓患者无症状肺栓塞的应用

目的　用99Tcm 大颗粒聚合白蛋白 (MAA)肺灌注显像研究肾病综合征伴下肢深静脉血栓患者的无症状肺栓塞发病情况。方法　 75例肾病综合征伴下肢深静脉血栓而无任何肺部疾病临床症状的患者 ,均经临床和超声检查证实。所有患者同时进行99Tcm MAA下肢静脉和肺灌注显像 ,其中 45例并行99Tcm DTPA肺通气显像。结果　① 75例患者中有 83% (62例 )发生下肢窝静脉以下血栓 ;②99Tcm MAA肺灌注显像示 61% (4 6例 )患者发生肺栓塞 (2 8例为单侧肺栓塞 ,18例为双侧肺栓塞 ) ;③ 45例患者99Tcm DTPA肺通气显像未见异常。结论　大部分肾病综合征下肢深静脉血栓患者伴有无症状性肺栓塞 ;对下肢深静脉血栓患者肺显像应作为常规检查     

下肢深静脉血栓治疗中下腔静脉滤器的临床应用

目的探讨下腔静脉滤器(IVCF)在下肢深静脉血栓治疗中预防肺栓塞的安全性、有效性。方法31例确诊为下肢深静脉血栓的患者于其他治疗前置入IVCF,共置入滤器31支,其中Simmon Nitinol滤器(SNF)7支,Trap Ease滤器(TEF)18支,可回收式Opt Ease滤器(OEF)6支,滤器均放置于肾静脉开口之下的下腔静脉。滤器放置后对18例下肢深静脉血栓行抗凝溶栓治疗,13例行手术取栓。结果31例IVCF置入全部成功,其中,SNF滤器倾斜3例,倾斜角度均小于15°。术后随访1～38个月,无1例症状性肺栓塞发生,无其他相关并发症。下肢深静脉血栓经治疗后,症状及体征消失或缓解。结论下肢深静脉血栓治疗中,IVCF置入可有效预防肺栓塞的发生,但需精心选择手术适应证、手术指征和合适的滤器。     

机械性血栓清除装置治疗深静脉血栓的临床研究现状

相对于传统溶栓治疗,机械性血栓清除术具有即刻恢复血流、缩短溶栓时间、减少溶栓剂剂量等优势,是治疗深静脉血栓最有前景的方案。本文就目前临床常用于深静脉血栓治疗的机械性血栓清除装置进行综述如下。     

机械性血栓清除术联合同期髂静脉支架植入治疗合并左髂静脉受压综合征的急性下肢深静脉血栓形成

目的：评价经皮机械性血栓清除术联合同期髂静脉支架植入治疗合并左髂静脉受压综合征的急性下肢深静脉血栓（DVT）形成的可行性、安全性及有效性。 方法：选取2015年4月-2017年6月收治左髂静脉受压综合征伴急性下肢DVT的患者33例,发病时间6 h-14 d,平均年龄（57.97±14.44）岁。所有患者均在滤器保护下进行治疗。AngioJet血栓清除术、球囊扩张和髂静脉支架植入均在同期完成,术后保留鞘管予以溶栓治疗,每天复查造影,若血栓完全溶解,取出下腔静脉滤器并结束溶栓。术后第1、3、6、12个月进行门诊随访,行彩色超声和（或）下肢静脉造影检查了解下肢深静脉及髂支架内血流通畅情况。 结果：33例患者均同期完成手术,技术成功率100%,AngioJet抽吸时间为（224.70±72.78）s,溶栓时间（34.00±15.37）h,尿激酶用量（112.58±49.92）万U。33例患者同期植入髂静脉支架33枚。血栓清除率Ⅲ级患者29例,血栓清除率Ⅱ级患者4例。无出血、症状性肺栓等严重并发症发生。术后随访1例患者术后两月血栓复发,32例患者术后随访超声和（或）下肢静脉造影检查提示下肢深静脉及髂静脉支架内血流通畅。 结论：机械性血栓清除术联合同期髂静脉支架植入治疗合并左髂静脉受压综合征的急性下肢深静脉血栓形成是一种安全有效的方法。     

Mechanical thrombectomy of massive pulmonary embolism using an Arrow-Trerotola percutaneous thrombolytic device

Mechanical thrombectomy of a large central thrombus in massive pulmonary embolism is a new option for the treatment of this serious condition. The special mechanical devices designed to fragmentize a blood clot include the Arrow-Trerotola percutaneous thrombolytic device (PTD), the use of which in the pulmonary arteries has not yet been reported. The case of massive embolism into the left pulmonary artery with subsequent collapse is to demonstrate the immediately clinically successful treatment using the PTD. Our initial experience with the PTD shows that its use is a safe and quick procedure. Received 1 December 1997; Revision received 30 January 1998; Accepted 16 March 1998     

Transjugular intrahepatic portosystemic shunt in a patient with cavernomatous portal vein occlusion

A 23-year-old woman with liver cirrhosis secondary to primary sclerosing cholangitis was referred to us for the treatment of recurrent bleeding from esophageal varices that had been refractory to endoscopic sclerotherapy. Her portal vein was occluded, associated with cavernous transformation. A transjugular intrahepatic portosystemic shunt (TIPS) was performed after a preprocedural three-dimensional computed tomographic angiography evaluation to determine feasibility. The portal vein system was recanalized and portal blood flow increased markedly after TIPS. Esophageal varices disappeared 3 weeks after TIPS. Re-bleeding and hepatic encephalopathy were absent for 3 years after the procedure. We conclude that with adequate preprocedural evaluation, TIPS can be performed safely even in patients with portal vein occlusion associated with cavernous transformation.     

Amplatz血栓消融器治疗下肢深静脉血栓(附18例分析)

目的：报告Amplatz血栓消融器治疗下肢深静脉血栓的应用情况。方法：回顾2001～2002年18例下肢深静脉血栓，腔髂静脉(n=2)，髂静脉(n=6)，髂股静脉(n=9)，股静脉(n=1)，在临时性／永久性下腔静脉滤器的保护下，经患侧腘静脉(n=10)和健侧股静脉(n=8)为入路行ATD血栓消融术。结果：13例经ATD血栓消融术后，血栓即时清除成功，占72．2％，ATD启动平均时间79．2s，血栓清除率在20％～99％，平均70．3％，17例患者需辅助治疗，占94．4％(17／18)，12例行Stent置入术，13例行经皮血管成形术，2例行经导管血栓抽吸术，9例行血栓药物溶解术，平均随访6个月均未复发DVT。结论：在下腔静脉滤器保护下，ATD是治疗下肢深静脉血栓的有效方法。     

Transjugular intrahepatic portosystemic shunt after previous recanalization of a chronically thrombosed portal vein via a transmesenteric approach

We report a cirrhotic patient with complete occlusion of the portal vein with marked cavernous transformation due to chronic thrombosis in whom a transjugular intrahepatic portosystemic shunt (TIPS) was successfully created after direct minilaparotomy mesenteric vein catheterization, lysis and aspiration of the thrombus, and stenting in the portal vein. The methods used, we believe, provide a new technique for performing TIPS in chronically thrombosed portal veins in which previously no effective surgical therapeutic options were available. Received: 0/00/00/Accepted: 0/00/00     

一例战斗机飞行员深静脉血栓形成并文献复习

目的探讨深静脉血栓形成与飞行的关系、诊断方法和预防措施。方法结合收治的1例男性高性能战斗机飞行员的临床资料及复习文献,对深静脉血栓形成与飞行的关系及发生机制进行综合分析。结果该飞行员入院前2月无诱因出现右下肢疼痛,当地医院行抗炎药物治疗15d,疼痛减轻。入院前2周出现咳嗽、咯血伴左侧胸痛,无发热。经血管超声、肺部CT等检查,诊断为:深静脉血栓形成;肺栓塞。给予抗凝等治疗后症状缓解。3个月后,一般日常活动无明显不适出院。结论:飞行不合格。结论战斗机的高载荷造成血管壁的轻微损伤,抗荷服对血管的压迫造成的血流淤滞,座舱内缺氧、振动、有毒气体及电磁辐射可能是促进飞行员静脉血栓形成的原因。     

Detection of deep venous thrombosis: Prospective comparison of MR imaging and sonography

Seventy-five patients (41 women and 34 men, 20-85 years old) with clinically suspected deep venous thrombosis (DVT) were examined with MR imaging and sonography. In 26 patients, the final diagnosis was acute femoropopliteal DVT. The sensitivity of MR imaging for detecting this disease was 100% with a 95% confidence interval (CI) of 87-100%; the specificity was 100% with a CI of 92-100%; and the accuracy was 96% with a CI of 89-99%. The correspond- ing sensitivity of sonography was 77% with a CI of 53-92%; the specificity was 98% with a CI of 89-100%; and the accuracy was 83% with a CI of 72-90%. In four of the 75 patients, MR images revealed thrombus of the pelvis (n=1) or calf (n=3) without femoropopliteal involvement. The estimated prevalence of isolated calf and/or pelvic DVT was 5% with a CI of 1-13%. MR imaging is significantly more sensitive (P=.02) and accurate (P < .01) than sonography in the detection of lower extremity DVT, but there was no difference in the specificity of MR imaging and that of sonography (P=.31).     

机械血栓清除术治疗急性下肢深静脉血栓患者围术期护理

目的 探讨机械血栓清除术治疗下肢深静脉血栓围手术期护理措施.方法 回顾性分析2015年1月至2016年2月,在血管外科行机械血栓清除术的9例患者的临床资料,总结其护理方法,探讨护理要点.结果 患者均成功完成机械血栓清除治疗,9例患者术后均恢复静脉血流.经过术后严密的治疗护理,患者下肢肿胀症状均明显改善(P＜0.05),无围术期并发症发生.结论 机械血栓清除术治疗下肢深静脉血栓围术期护理尤为重要,掌握护理重点,做好相应的护理措施,有助于患者病情恢复.     

经腘静脉介入治疗下肢深静脉血栓形成

目的：探讨经腘静脉介入治疗下肢深静脉血栓的临床应用价值。方法：对32例下肢深静脉血栓形成患采用经患侧腘静脉入路综合性介入治疗,其中血栓抽吸18例,血栓消融28例,腔内血管成形29例,共植入血管支架42枚。结果：技术成功率为100％,治疗后闭塞血管开放,双下肢周径差＜1cm,下肢活动正常。结论：经腘静脉介入治疗下肢深静脉血栓操作简便、安全有效。     

Great saphenous vein thrombosis causing acute pulmonary embolism suggested by combined CT venography and pulmonary angiography

Pulmonary embolism is a life-threatening condition, which is most commonly related to deep vein thrombosis. Varicose vein thrombosis, a very common disease, is seldom reported as being related to pulmonary embolism. We present combined computed tomography venography and pulmonary angiography findings suggesting that thrombosed varicosities of a great saphenous vein caused acute pulmonary embolism in a 30-year-old male.     

Suspected pulmonary embolism and deep venous thrombosis: A comprehensive MDCT diagnosis in the acute clinical setting

Both pulmonary arterial and peripheral venous sides of venous thromboembolism (VTE) can now be efficiently and safely investigated by multi-detector CT (MDCT) at the same time by a combined CT angiography/CT venography protocol. In the emergency setting, the use of such a single test for patients suspected of suffering from VTE on a clinical grounds may considerably shorten and simplify diagnostic algorithms. The selection of patients to be submitted to MDCT must follow well-established clinical prediction rules in order to avoid generalized referral to CT on a generic clinical suspicion basis and excessive population exposure to increased ionizing radiation dose, especially in young patients. Clinical and anatomical wide-panoramic capabilities of MDCT allow identification of underlying disease that may explain patients' symptoms in a large number of cases in which VTE is not manifest. The analysis of MDCT additional findings on cardiopulmonary status and total thrombus burden can lead to better prognostic stratification of patients and influence therapeutic options. Some controversial points such as optimal examination parameters, clinical significance of subsegmentary emboli, CT pitfalls and/or possible falsely positive diagnoses, and outcome of untreated patients in which VTE has been excluded by MDCT without additional testing, must of course be taken into careful consideration before the definite role of comprehensive MDCT VTE "one-stop-shop" diagnosis in everyday clinical practice can be ascertained.